Optimizing Abdominal Aortic Aneurysm Imaging to Improve Access, Clinical Utility, and Value-Based Medicine

Area of Science:

• Cardiovascular Imaging
• Health Economics
• Value-Based Care

Background:

• Abdominal aortic aneurysm (AAA) management relies heavily on imaging, but current practices often lead to overuse or underuse, impacting patient safety and healthcare costs.
• A need exists for a value-based imaging pathway that balances clinical effectiveness, equity, and resource stewardship in AAA care.

Purpose of the Study:

• To outline a value-based imaging pathway for abdominal aortic aneurysm (AAA) care.
• To emphasize clinical safety, equity, and resource stewardship in AAA imaging strategies.

Main Methods:

• A narrative synthesis of contemporary guidelines and primary studies was conducted.
• The synthesis focused on developing a risk-adapted, ultrasound-lean imaging strategy.

Main Results:

• An ultrasound-first strategy is recommended for unrepaired AAAs.
• Targeted, one-time ultrasound screening for at-risk populations and a single computed tomography angiogram (CTA) before repair are supported.
• Post-endovascular aneurysm repair (EVAR) follow-up should prioritize duplex ultrasonography (DUS) ± contrast-enhanced ultrasound (CEUS), with CTA/MRA reserved for specific complications.

Conclusions:

• A risk-adapted, ultrasound-lean imaging strategy for AAA care preserves outcomes.
• This strategy reduces cumulative radiation exposure, lowers expenditures, and improves patient access.
• The proposed pathway advances value-based cardiovascular care by optimizing imaging utilization.